The Clinical Competency Exam (CCE) is the final exam on the pathway to Fellowship with the Royal Australian College of General Practitioners (RACGP). Candidates are presented with nine clinical cases: four case-based discussions with an examiner, and five clinical encounters interacting with a simulated patient (role-player) while the examiner observes and assesses.  

Each CCE case is 15-minutes in duration with an initial 5-minutes of reading time, via Zoom.    

The competency, communication, features dominantly in this exam. Understanding how you will be assessed on your communication skills in the CCE will enable you to prepare well and hone your performance to successfully pass this exam. 

A key resource to understand how you will be assessed on this competency is the RACGP CCE Competency Rubric. Pages 1-4 of this rubric outline the required knowledge (holistic approaches and perspectives) and attitudes (empathy, self-awareness, curiosity, professionalism, respect for patient autonomy) as well as the required skills, such as cultural understanding and responsiveness. 

 Included in the competency are high-level communication skills, such as de-escalation and negotiation skills.  The rubric outlines the communication and consultation skills needed by a Fellowed GP in Australia, including how these skills can be demonstrated (i.e., the performance lists and criteria). This resource basically tells you what you need to do, and how you will be assessed. 

So, what are effective communication skills? 

Effective communication is not just about conveying information in a clear and understandable manner. Though important, you are also being assessed on your listening and responding skills, and creating a safe, respectful environment for patients to share and confide in you.  

Demonstrating professionalism and competence in your medical practice is also important. This skill is central to being an effective, independent Fellowed general practitioner (GP), and therefore a major aspect of what examiners will be assessing.  

So, how can you be a more effective communicator for the CCE? 

Be Clear and Concise 

In the pressure of a clinical exam, it’s easy to skip information or get sidetracked. However, examiners value clarity and conciseness. Your ability to communicate a diagnosis, a treatment plan, or patient education, effectively in a brief but informative manner, will showcase your clinical competency. 

Structure your communication.  

Begin by introducing yourself clearly, asking the patient for their preferred name, and then listening to their story. Practice using a structure to organise your consultations. For example, there are many clinical communication models, such as the Calgary-Cambridge Guide, which defines a series of chronological stages for a consultation: Initiating the session, Gathering information, Physical examination, Explanation and planning, and Closing the session. Being organised and structured will allow the examiner to follow your clinical reasoning and problem-solving skills throughout the case, enabling them to give you the maximum marks possible. 

Use simple language: Patients are unlikely to understand complex medical terms, so always aim to explain things in a straightforward and approachable way. At the same time, if you notice in the scenario that the patient is highly educated or also from a medical background, it’s important to take this information into consideration, and adjust your language accordingly, while also checking in with the patient about their understanding. 

Attentive Listening 

One of the cornerstones of good communication is listening attentively. It is not just about hearing what the patient says. Attentive listening is about understanding your patients’ concerns, acknowledging their feelings, clarifying your understanding and responding appropriately. During the CCE, your ability to listen attentively, build rapport and show empathy will be scrutinised. The best way to demonstrate these skills is through attentive listening which includes noticing and using  non-verbal communication, paraphrasing and reflecting what has been said, clarifying, and asking probing or open-ended questions. For example: 

  • Non-verbal cues: Show you’re listening through nodding, maintaining eye contact, and using open body language. Even though the exam is via Zoom, demonstrating these skills and using appropriate body language is key. 
  • Reflect and paraphrase: To show understanding, repeat key points from the patient’s story. “So, you’re saying that your symptoms started two weeks ago, and has been getting worse since then?” 
  • Ask clarifying questions: Where necessary, ask the patient to elaborate. This demonstrates not only your listening skills but also your ability to guide the conversation to elicit key information. 

Managing Difficult Conversations 

Difficult conversations, which include delivering bad news, discussing a terminal diagnosis, or addressing a patient’s non-compliance, are often a component of the CCE. Your ability to handle these situations with professionalism, empathy, and respect will be assessed. A helpful acronym to remember is SPIKES. It is commonly used as a memory prompt for the structured stepped approach for breaking bad news. SPIKES stands for:  

  • Setting up the interview (ensure privacy, comfortable setting) 
  • Patient perception (ask what they know about their condition) 
  • Invitation (ask how much information they want) 
  • Knowledge (provide clear, honest information) 
  • Emotions (respond to their feelings) 
  • Strategy (discuss the next steps in their care) 
  • Encourage questions: Patients may need time to process information. Encourage them to ask questions and address their concerns. 

For the CCE, it is important to prepare and practice cases which feature difficult conversations, so you can receive feedback on your performance, and adjust your strategies and techniques accordingly. With practice, you will be able to stay calm, composed, and sensitive to the patient’s feelings.  

Lastly… 

Effective communication is not just a technical skill – it’s the cornerstone of a successful GP career, one that you will use for many years to come. By focusing on clarity, empathy, active listening, and professionalism, you’ll be well-prepared to shine in your clinical competency exams. 

Remember, the CCE is an opportunity to demonstrate your ability to communicate empathetically, share clear advice, and handle complex situations with care and competence. Keep practicing your communication skills, seek feedback, and make sure to reflect on your interactions with patients during your clinical work, as these are all opportunities to hone your skills for the CCE. With these tools in your communication toolkit, you’ll be prepared to tackle your last Fellowship exam with confidence. 

References 

Cuncic, Arlin. (2024). Very Well Mind: 7 Active Listening Techniques For Better Communication. Accessed on 12/2/25 from: https://www.verywellmind.com/what-is-active-listening-3024343  

MacMillan Cancer Support. (2025). Difficult Conversations. Accessed on 12/2/25 from: https://www.macmillan.org.uk/coronavirus/healthcare-professionals/difficult-conversations#:~:text=Find%20out%20what%20the%20person,everything%20you’ve%20told%20them 

Medical Director. (2018) Communication in General Practice – is there a better way? Accessed on 16/7/24 from : https://www.medicaldirector.com/news/clinical-practice/communication-in-general-practice-is-there-a-better-way/#:~:text=The%20best%20thing%20any%20General,you%20really%20don’t%20know.  

Physiopedia. (2024). Calgary-Cambridge Guide to the Medical Interview – Initiating the Session. Accessed on 12/2/25 from: https://www.physio-pedia.com/Calgary-Cambridge_Guide_to_the_Medical_Interview_-_Initiating_the_Session 

The Royal Australian College of General Practitioners Ltd. (2024). RACGP CCE Competency Rubric. Accessed on 12/2/25 from: https://www.racgp.org.au/getmedia/f93428f5-c902-44f2-b98a-e56d9680e8ab/Clinical-Competency-Rubric.pdf.aspx